Provider Demographics
NPI:1376069518
Name:DAMIN, ALYSIA M
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:M
Last Name:DAMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 ARMSTRONG CIR APT D
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99506-1440
Mailing Address - Country:US
Mailing Address - Phone:315-868-0168
Mailing Address - Fax:
Practice Address - Street 1:12580 OLD SEWARD HWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3506
Practice Address - Country:US
Practice Address - Phone:907-891-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist